CPT 99203: New Patient Office Visit, Low Complexity
CPT 99203 reports a new patient office or outpatient visit with low medical decision making or 30-44 minutes of total time. In 2026 Medicare pays about $117.57 non-facility (3.52 total RVUs times the $33.4009 conversion factor) and about $71.48 in a facility.
- Code type
- New patient E/M (office/outpatient)
- 2026 non-facility
- $117.57 (3.52 RVUs)
- 2026 facility
- $71.48 (2.14 RVUs)
- Time (if used)
- 30-44 minutes total on the date
What is CPT 99203 used for?
CPT 99203 is an office or outpatient visit for a new patient requiring low medical decision making or 30-44 minutes of total time on the date of service. It is the mid-lower new-patient level and one of the most common new-patient codes in outpatient practice, capturing first visits for a couple of minor complaints, a stable chronic condition, or a new acute uncomplicated illness that needs some workup.
Choose the level by MDM or by total time; history and exam must be medically appropriate but no longer set the level under the 2021 E/M framework. The new-patient status turns on the three-year rule, no prior face-to-face service from you or a same-specialty, same-subspecialty physician in your group within three years, so verify that before reaching for any new-patient code.
How much does 99203 pay in 2026?
99203 carries 3.52 non-facility RVUs and 2.14 facility RVUs. At the 2026 conversion factor of $33.4009:
| Setting | Total RVUs | 2026 Medicare allowed |
|---|---|---|
| Non-facility (office) | 3.52 | ~$117.57 |
| Facility | 2.14 | ~$71.48 |
The office figure is higher because the practice, not a facility, carries the staff and overhead reflected in the practice-expense RVUs. Medicare pays 80 percent of the allowed amount after the deductible; the patient or secondary owes the 20 percent coinsurance. Confirm your locality-adjusted rate with the Medicare fee calculator.
What documentation supports 99203 over 99202?
99203 requires low MDM, typically two or more self-limited problems, one stable chronic illness, or one acute uncomplicated illness, usually paired with some data review such as ordering labs, reviewing outside records, or getting an independent history. If the visit is a single minor problem with no data and minimal risk, it is 99202. Example: a new patient with a stable thyroid condition and a new tension headache, for whom you order a TSH and review prior records, seen for 35 minutes, is a clean 99203 at about $117.57.
How does 99203 fit the new-patient family?
New-patient work often meets low or moderate complexity because you are building the record from nothing. Watch that you are not defaulting to 99203 when the data and risk actually support 99204, which pays roughly $60 more; that reflex is quiet downcoding across a panel.
Frequently asked questions
When coding by time, 99203 requires 30-44 minutes of total time the physician or QHP spends on the patient on the date of service, including pre-visit chart review, the encounter, and post-visit documentation and orders completed before midnight. If you code by MDM instead, low complexity controls and time is irrelevant.
The 2026 national non-facility allowed amount is about $117.57 (3.52 total RVUs times $33.4009). In a facility place of service it is about $71.48 (2.14 RVUs). Medicare pays 80 percent after the deductible and the patient or secondary plan owes 20 percent.
99203 requires low MDM, typically two or more self-limited problems, one stable chronic illness, or one acute uncomplicated illness, often with some data review such as labs or outside records. If the visit is a single minor problem with no data and minimal risk, it is 99202. Document the problem count and data reviewed.
Sources & further reading
Reviewed by the ImmediCare Solutions RCM team
Certified billers and coders handling claims across 50+ specialties nationwide. This entry is reviewed against current payer policy and CMS rules. Last review: Jul 5, 2026.
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